Enteral feeding apparatus

ABSTRACT

Embodiments of the present invention include a enteral feeding apparatus and/or system in which an enteral feeding pump can be configured to deliver enteral formula to a patient in accordance with a delivery parameter determined using patient information associated with a patient to be treated and formula information associated with an enteral formula to be delivered to the patient. Exemplary embodiments can determine an estimated daily caloric intake for a patient and can configure the enteral feeding pump to satisfy the caloric requirements of the patient. Exemplary embodiments are also able to monitor the delivery of the enteral formula to ensure that the patient is being properly treated.

BACKGROUND

Embodiments of the present invention relate to the art of enterallyfeeding, and, in particular, concern the ability to enhance the controlof delivery responsive to patients needs.

Patients that are unable to take food or medications due to theinability to swallow typically receive nutrition intravenously through acatheter, which is referred to as parenteral nutrition, or through afeeding tube, which is referred to as enteral nutrition. Enteral feedingis typically used to feed patients when there is no contraindication ofthe gastrointestinal tract present. In critical care areas, and for longterm use, enteral feeding is advantageous and the preferred method offeeding because it provides nutrition and preserves the intestinalmucous membrane.

While delivery of nutrition enterally is useful and beneficial topatients, its effectiveness can be dependent on proper ordering,administration and monitoring of the enteral feeding. The administrationof enteral nutrition is a multidisciplinary process that can be hindereddue to breaks in communication, complexities of modern healthcare, anddecreasing staff both at the bedside and at the nutritional supportlevel. Risk of complications associated with the enteral delivery offood, increases as a result of gaps in communication.

Enterally feeding can be implemented using enteral feeding pumps thatgenerally deliver a specified volume of formula to the patient at a rateselected by the user. For example, a healthcare provider can set anenteral feeding pump to deliver a prescribed volume of feeding formulaat a prescribed rate. Once the pump is set, the pump delivers thefeeding formula to the patient at the selected rate. A single enteralfeeding pump can be a shared resource for use by a group of patients ina hospital. Each patient can have distinct enteral feeding requirements.If a feeding pump is utilized for different patients and is not properlyre-programmed based on the enteral feeding requirements of the patientbeing fed, the patient can be at risk for improper feeding, which ishighly undesirable.

Despite the attention given by healthcare providers to the managementand practice of providing adequate nutrition to patients, the patientsmay be malnourished. For example, factors impeding the daily delivery ofenteral nutrition, such as interruptions of enteral feeding to change apatient's body position or other prescribed orders, can result inunderfeeding of patients.

SUMMARY

The present invention is, in one aspect, an enteral feeding apparatusthat includes an enteral feeding pump and a controller. The enteralfeeding pump delivers enteral feeding formula to a patient and thecontroller controls delivery of the enteral feeding formula based on adelivery parameter determined using a relationship between a patientparameter associated with the patient and a caloric parameter associatedwith the enteral feeding formula.

In some embodiments, the patient parameter can be an estimated dailycaloric intake requirement for the patient, the caloric parameter can bea quantity of calories per a specified volume of the enteral feedingformula, and/or the delivery parameter can be a delivery rate of theenteral feeding formula. The daily estimated caloric intake requirementfor the patient can be calculated by the controller based on patientinformation associated with the patient. In some embodiments, theestimated daily caloric intake requirement is calculated using at leastone of the Weir equation, an indirect calorimetry respiratory quotientformula, the Harris Benedict equation, an ideal bodyweight equation, theDevine formula equation, an adjusted body weight equation, and the like.The delivery rate can be determined by generating a quotient of theestimated daily caloric intake requirement divided by the quantity ofcalories per specified volume and dividing the quotient by a time periodover which the enteral formula is to be delivered.

With respect to caloric intake, the controller can monitor usage of theenteral feeding pump to identify a quantity of calories administered tothe patient. For example, the controller can determine when theestimated daily caloric intake requirement is unmet based on acomparison of the quantity of calories administered to the patient andthe estimated daily caloric intake requirement. A treatment history forthe patient can be generated by the controller and can include thequantity of calories delivery by the enteral feeding pump.

The enteral feeding apparatus of the present invention can also includea communication port, a computer storage, and/or an input device. Thecommunication port can communicatively couple the apparatus to at leastone device. The controller can control the communication port to receivethe patient parameter and/or caloric parameter and/or can control thecommunication port to transmit the treatment history to a medicalrecords database to incorporate the treatment history into an electronicmedical record associated with the patient. The computer storage canreceive the patient parameter and/or the caloric parameter. Thecontroller can interface with the storage to retrieve the patientparameter and/or the caloric parameter. The input device can receive aselection from a user of the enteral feeding formula and patientinformation, which can be used by the controller to identify the patientparameter and the caloric parameter.

In some embodiments, the controller can identify when the estimateddaily caloric intake requirement of the patient is unmet and determine arate at which to deliver a compensatory bolus to compensate for a dailycaloric intake deficit of the patient. The controller can control theenteral feeding pump to deliver the enteral feeding formula at the rateto deliver the compensatory bolus.

In another aspect, an enteral feeding system that includes an enteralfeeding apparatus is disclosed. The enteral feeding system can include apump, computer storage, and a server. The pump delivers enteral feedingformula to a patient. The computer storage stores patient informationand/or formula information. The server is in communication with theenteral feeding pump and the storage. The server and/or the enteralfeeding apparatus configures the enteral feeding pump to deliver theenteral feeding formula to the patient to satisfy the caloric intakerequirement of the patient using a delivery parameter. The deliverparameter used to configure the pump is based on a relationship betweenthe estimated daily caloric intake requirement and a caloric parameterincluded in the enteral formula information. The server and/or theenteral feeding apparatus can determine the caloric intake requirementof a patient based on patient information associated with a patient.

The server and/or the enteral feeding apparatus can identify enteralformula information associated with an enteral feeding formula selectedto be administered to the patient. The caloric parameter can be aquantity of calories per a specified volume of the enteral feedingformula and/or the delivery parameter can be a delivery rate of theenteral feeding formula. The server and/or the enteral feeding apparatuscan determine the delivery rate by generating a quotient of theestimated daily caloric intake requirement divided by the quantity ofcalories per a specified volume of feeding formula and dividing thequotient by a time period over which the enteral formula is to bedelivered.

In some embodiments, the server and/or the enteral feeding apparatus canmonitor usage of the pump to identify a quantity of caloriesadministered to the patient, can determine when the estimated dailycaloric intake requirement is unmet based on a comparison of thequantity of calories administered to the patient and the estimated dailycaloric intake requirement, and/or can generate an enteral feeding pumptreatment history for the patient that includes the quantity of caloriesadministered.

Furthermore, the server and/or the enteral feeding apparatus canidentify when a caloric intake requirement of the patient is unmet anddetermine a rate at which to deliver a compensatory bolus to compensatefor the estimated daily caloric intake requirement of the patient thatis unmet.

In yet another aspect, an enteral feeding system is disclosed thatincludes a computing system having at least one computing device. Thecomputing system determines a caloric intake requirement of a patientbased on patient information associated with a patient, identifiesenteral formula information associated with a enteral feeding formulaselected to be administered to the patient, and configures an enteralfeeding pump to deliver the enteral feeding formula using a deliveryparameter determined based on a relationship between the estimatedcaloric intake requirement and a caloric parameter included in theenteral formula information. The caloric parameter can be a quantity ofcalories per a specified volume of the enteral feeding formula and thedelivery parameter can be a delivery rate determined by generating aquotient of the estimated daily caloric intake requirement divided bythe quantity of calories per specified volume and dividing the quotientby a time period over which the enteral formula is to be delivered.

In still a further aspect, a method of administering enteral formula toa patient is disclosed. The method include determining an estimateddaily caloric intake requirement for a patient based on patientinformation and configuring an enteral feeding pump to deliver theenteral feeding formula to satisfy the estimated daily caloric intakerequirement of the patient using a delivery parameter determined basedon a relationship between the estimated daily caloric intake requirementand a caloric parameter included in the enteral formula information. Themethod can also include administering the enteral feeding formula inresponse to the configuring, monitoring a quantity of calories deliveredby the enteral feeding pump, and/or generating a treat history for thepatient, the treatment history including the quantity of calories.

The enteral feeding pump of the present invention can be responsive toan estimated daily intake requirement so that the pump is configured tomeet the feeding requirements of the patient and can be monitored toindicate when enteral feeding requirements are not being met. In thismanner, embodiments of the present invention can improve patient carefor enterally fed patient by ensuring patients caloric requirements arebeing met and that their nutritional status is not comprised. This helpsprevent malnourishment, reduce health complications, and reduce lengthof stay in hospitals for enterally fed patients.

Additionally, embodiments of the present invention can implementcompensatory bolus protocol to improve caloric intake for patients thathave prolonged cessation of enteral feeding and/or who have frequentfeeding interruptions in the course of the day. Using this approach,embodiments of the present invention can compensate for underfeeding ofpatients, which can commonly occur in hospital settings.

Any combination of the above features is envisaged. Other objects andfeatures will become apparent from the following detailed descriptionconsidered in conjunction with the accompanying drawings, wherein likereference numerals in the various drawings are utilized to designatelike components. It is to be understood, however, that the drawings aredesigned as an illustration only and not as a definition of the limitsof the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of an exemplary enteral feeding apparatus.

FIG. 2 is an exemplary embodiment of an enteral feeding system.

FIG. 3 is another exemplary embodiment of an enteral feeding system.

FIG. 4 is an exemplary implementation of embodiments of an enteralfeeding apparatus and/or system in a hospital environment.

FIG. 5 illustrates an exemplary screen view to facilitate userinteraction with embodiments of an enteral feeding apparatus and/orsystem.

FIG. 6 an exemplary screen view for entering and viewing patientinformation.

FIG. 7 illustrates entering patient information for use in determiningpatient parameters.

FIG. 8 illustrates programming a particular enteral feeding protocol todeliver a compensatory bolus.

FIG. 9 illustrates an exemplary treatment history.

DETAILED DESCRIPTION

Exemplary embodiments include an enteral feeding apparatus and/or systemthat provides computerized configuration and/or monitoring of enteralfeeding to ensure proper nourishment of patients who are enterally fed.Exemplary embodiments of the enteral feeding apparatus and system can beconfigured to deliver enteral feeding formula to a patient based onpatient information and formula information, and can monitor a patient'scaloric intake to determine whether the patient is meeting the patient'scaloric intake requirements. Patients that do not meet their caloricintake on a daily basis for diverse reasons (e.g., interrupted feedings,unintentional skipped feeding, held feedings for scheduled test and/orprocedures) can compromise their nutritional status leading tomalnutrition, increased health complications and increased length ofstay in hospitals, especially in critically ill patients. Becauseenterally feeding patients can pose a challenge in meeting andmaintaining adequate nutrition, continuous surveillance of enteralcaloric intake and recognition of enteral caloric deficits is proposed.

Exemplary embodiments can include treatment histories that can include adaily caloric intake of patient, which can be used by healthcareproviders to ensure that patients are receiving accurate nutrition andthat caloric goals are being met for enterally fed patients. Dailymonitoring of total enteral caloric intake is advantageous and can beused to prevent malnourishment when enteral feeding is frequentlyinterrupted and/or ceased. A real time and accurate record of dailyenteral caloric intake can enhance management of patient's nutritionalcaloric requirement.

FIG. 1 depicts a block diagram of an exemplary enteral feeding apparatus100 that can include a display 105, one or more data entry devices 110,an enteral feeding pump 115 (hereinafter “pump 115”), computer storage120, a communication port 145, and one or more processors or controllers150 (hereinafter “controllers 150”). In some embodiments, the apparatus100 can interface with a patient information database 160, a formuladatabase 170, and/or a medical records database 180. The display 105 canbe a liquid crystal display (LCD), plasma display, cathode ray tube(CRT) display, and the like, and can include touch screen capabilities.The one or more data entry devices 110 can include, for example, keypad,keyboard, touch screen, microphone, mouse, track ball, and the like. Thepump 115 can delivery enteral formula to a patient and can beimplemented using, for example, a volumetric pump with a rotaryperistaltic pumping mechanism and the like.

The apparatus 100 can be used to administer enteral formula to patientsthat are unable to normally ingest food due to, for example, theinability to swallow, and can deliver enteral formula to a patient viaan implantable or temporary enteral access device, such as anaso-gastric feeding tube (NGT), a percutaneous endoscopic gastrostomy(PEG) device, and the like, using the pump 115. Embodiments of theapparatus 100 can deliver enteral formula to a patient based on patientparameter corresponding to the patient being enterally fed and formulainformation corresponding to an enteral formula being delivered to apatient. The apparatus 100 can monitor its operation to ensure that thefeeding requirements of the patient are being satisfied.

The storage 120 can include computer readable medium technologies, suchas a floppy drive, hard drive, compact disc, tape drive, Flash drive,optical drive, read only memory (ROM), random access memory (RAM), andthe like. In some embodiments, the storage 120 can store patientinformation 122, treatment histories 124 for patients, formulainformation 126, and applications 128 for operating the apparatus 100,which can include an enteral feeding management system 130. In someembodiments, the patient information 122 and treatment histories 124 canbe stored in the patient database 160, treatment histories 124 can bestored in the medical records database 180, and/or the formulainformation 126 can be stored in the formula database 170. While thedatabases 160, 170, and 180 have been illustrated separately, thoseskilled in the art will recognize that two or more of the databases 160,170, and 180 can be combined into a single database. The databases 160,170, and 180 can be implemented as a relational database, a hierarchaldatabase, and the like, and can use eXtensible Mark-up Language (XML),structured query language (SQL), and the like.

The patient information 122 is related to patients that are treatedusing the apparatus 100. The patient information 122 can include apatient name, patient identification number, height, weight, gender,age, allergies, as well as patient parameters, such as body mass index(BMI), body surface area (BSA), ideal body weight, adjusted body weight,an estimated daily caloric intake requirement, and the like, for eachpatient. Patient information 122 can be retrieved for a particularpatient using, for example, a patient identifier, such as the patient'sname and/or patient identification number. The patient information 122can be sorted and/or listed by, for example, the patients name and/orpatient identification number.

The patient treatment histories 124 can be stored for each patienttreated using the apparatus 100. Each patient's treatment history can beassociated with that patient's patient information. The treatmenthistory 124 can include a daily enteral caloric count, a caloric goal,whether the nutritional caloric goal is met, a total amount of enteralformula fluid administered, time and duration for which the patient isenterally fed, whether and/or when compensatory boluses were delivered,and the like. In some embodiments, the caloric goal can be equal to theestimated daily caloric intake requirement of a patient.

The formula information 126 is related to enteral formulas that can beenterally delivered to a patient via the apparatus 100. The formulainformation 126 can include product names of enteral feeding formulas,names of manufacturers of the formulas, nutritional values of theformula including proteins, fats, carbohydrates, and electrolytesamounts (ex. potassium, magnesium, calcium, and phosphorous), as well ascaloric parameters, such as a quantity of calories per a specified unitvolume of the formula (e.g., calories per milliliters (cal/ml)),calories per bolus, and the like. The formula information 126 can besorted and/or listed by, for example, product name and/or manufacturer,and can be browsed and/or searched using key words or terms.

Applications 128, such as embodiments of the system 130, can includeinstructions for operating the apparatus 100 upon execution by one ormore of the controllers 150. The instructions can be implemented using,for example, C, C++, Java, JavaScript, Basic, Perl, Python, assemblylanguage, machine code, and the like. The storage 120 can be local orremote to the apparatus 100. The system 130 can include an enteralfeeding determination unit 132 (hereinafter “determination unit 132”), aconfiguration unit 134, a delivery monitor 136, a compensation unit 138,and a user interface 140.

The system 130 can be used to determine parameters for deliveringenteral formula to a patient via the pump 115 and can be used to monitoror track the operation of the pump to maintain a patient treatmenthistory, which can be used to evaluate, monitor, and determine theeffectiveness of the enteral feeding treatment. In some embodiments, thesystem 130 can identify ineffective enteral treatment and can implementcompensatory parameters for delivery of enteral formula to improve theeffectiveness of the treatment. In some embodiments, the patientinformation 122 and the formula information 126 can be integrated intothe system 130.

Using the determination unit 132, the controller 150 can calculateand/or retrieve a patient parameter to be used when configuring the pump115. For example, the determination unit 132 can be used by thecontroller 150 to determine patient parameters, such as a BMI, BSA,ideal body weight, adjusted body weight, an estimated daily caloricintake requirement for a patient, and the like. Embodiments of thedetermination unit 132 facilitate calculation of the estimated dailycaloric requirement using the patient information 122. For example, thedetermination unit 132 upon execution by the controller 150 can use anideal body weight of a patient, adjusted body weight for the patient, anadmission weight of the patient, the height of the patient, the genderof the patient, a body mass index (BMI) of the patient, a body surfacearea (BSA) of the patient, and the like, when calculating the estimateddaily caloric requirement of the patient. In some embodiments, thedetermination unit 132 can include instructions for calculating the BMIand BSA (m2) of the patient, which can be used to calculate theestimated daily caloric intake requirement for the patient.

The controller 150 can use one or more methods of calculation providedby the determination unit 132 to estimate caloric intake requirement(R_(kcals)). For example, the determination unit 132 can include theHarris-Benedict equation, an Ideal body weight equation, Indirectcalorimetry, Weir equation, Devine equation, a pediatric nutritionassessment calculation, and the like.

One form of Harris-Benedict equations that can be used to estimate thedaily intake requirement of a patient can be expressed as follows:Males: R _(kcals)=66.5+13.8*W+5*H−6.8*AFemales: R _(kcals)=655+9.6*W+1.8*H−4.7*A,where W is the calculation weight, which can be one of the actual weightof the patient, the admission weight, an ideal weight for the patient,an adjusted weight for the patient, and the like, expressed inkilograms, H is the height of the patient is centimeters, and A is theage of the patient in years. Another equation that can be used toestimate the daily intake requirement of a patient can be expressed asfollows:R _(kcals) =K*W,where K is specified number of kilocalories per kilogram per day, suchas 25 to 30 kilocalories and W is the calculation weight.

One form of the ideal body weight (IBW) equations can be expressed asfollows:Males: IBW=50 kg+2.3 kg*(Height [in inches]−60)Females: IBW=45.5 kg+2.3 kg*(Height [in inches]−60).

One form of the Devine equation can be expressed as follows:Males: IBW=50+2.3 kg per inch over 5 feetFemales: IBW=45.5+2.3 kg per inch over 5 feet.

One form of the adjusted body weight (ABW) equations can be expressed asfollows:Males: ABW=IBW+0.4*(actual weight−IBW)Females: ABW=0.25*(actual weight−IBW)+IBW.

The selected calculation can be dependent on a preference of a user ofthe apparatus 100, the unit department in which the patient is beingcared, hospital policy, and the like. In some embodiments, estimation ofthe daily caloric intake requirement can be dependent on the nutritionalstate of the patient, type of patient (ex. surgical, trauma, criticaland/or medical care), and the like. The determination unit 132 can alsobe used by the controller 150 to calculate supplemental protein and/orother nutritional supplement intake requirements for the patient. Whilesome of the methods of calculating patient parameters including an idealbody weight, an adjusted body, and an estimated daily caloric intakerequirement have been provided, those skilled in the art will recognizethat other methods of calculating the patient parameters can beperformed to determine the patient parameters.

Using the determination unit 132, the controller 150 can determine adelivery parameter based on a relationship between a patient parameterassociated with the patient and a caloric parameter associated with theenteral feeding formula. For example, execution of the determinationunit 132 by the controller 150 can facilitate determination of adelivery parameter based on a relationship between the estimated caloricintake requirement of a patient and a quantity of calories per aspecified volume of enteral formula. The delivery parameter can be adelivery rate at which the pump 115 is configured to deliver enteralformula to a patient. In some embodiments, the controller 150 candetermine the delivery rate by generating a quotient resulting from theestimated daily caloric intake requirement being divided by the quantityof calories per specified volume, and dividing the quotient by a timeperiod over which the enteral formula is to be delivered. In someembodiments, the user can set the time period over which the enteralformula is to be administered. In some embodiments, a default timeperiod can be used if one is not specified. In some embodiments, theuser can set the delivery rate and the determination unit 132 candetermine the time period over which the enteral formula is to bedelivered to satisfy the estimated daily caloric intake requirement ofthe patient.

The controller 150 can execute the determination unit 132 to generatepump limit parameters to control the pump's operational range. Forexample, the pump limit parameters generated can include a maximum ratelimit of enteral delivery, maximum rate limit for compensatory bolus,limitations on the administration of compensatory boluses, and the like.The maximum rate limit of delivery can identify the maximum amount ofenteral feeding to be delivered based on the patient's caloric intakerequirement and/or target rate of administration. The maximum limit forcompensatory bolus delivery can identify a maximum allowable rateincrease in compensating the patient's caloric deficit. The maximumlimit on the administration of compensatory bolus feeds can identify theallowable administration of compensatory bolus based on patient'sassessment of tolerance of the enteral feeding rate increase.

Using the configuration unit 134, the controller 150 can configure thepump 115 for delivery of the enteral feeding formula. The configurationunit 134 can be used to specify a configuration of the pump 115 foroperation using the enteral formula information 126, the patientinformation 122, a delivery parameter, pump limit parameters, and thelike. For example, the controller 150 can execute the configuration unit134 to control delivery of the enteral formula by the pump 115 using thedelivery parameter based on the relationship between a patient parameterassociated with the patient and a caloric parameter associated with theenteral formula. For embodiments in which the delivery parameter is adelivery rate of the pump 115, the controller 150 can use theconfiguration unit 134 to configure the pump 115 to deliver the enteralfeeding formula at the specified delivery rate. In this manner, theconfiguration unit 134 can be used to communicate with the pump 115 toset pump operation parameters so that the estimated daily caloric intakerequirement calculated using the determination unit 132 can be deliveredto the patient.

Upon execution of the delivery monitor 136, the controller 150 canmonitor and/or track the usage of the feeding pump 115 and can storetreatment information in the treatment history 124 for the patient. Forexample, the delivery monitor 136 can be used to maintain a log for theadministration of enteral formula to a patient. The log can includeformula information, patient information, and pump operation parametersused to program the apparatus 100, a volume of enteral formulaadministered over a specified period of time, a quantity of caloriesadministered to the patient by the pump 115 over a specified period oftime, a rate at which the pump administered the enteral formula, a startdate and time of treatment sessions, an end date and time of treatmentsessions, and the like. As the feeding pump 115 delivers the enteralformula, the delivery monitor 136 can be used by the controller 150 todetermine the enteral calories delivered, whether the daily caloricnutritional goal is met, a caloric deficit identifying a caloricquantity that is unmet, the total volume amount of nutritional formulaadministered, and the like. The delivery monitor 136 can be used by thecontroller 150 to transmit the treatment history to the medical recordsdatabase 180 for incorporation into the patient's medical record.

In some embodiments, to monitor a quantity of calories delivered to thepatient, the delivery monitor 136 can be in communication with a flowsensor in the pump 115, which can monitor the flow of the formulathrough the feeding tube. In some embodiments, the delivery monitor candetermine a quantity of calories delivered based on the delivery rate ofthe pump 115 and the time period over which the pump 115 has operated.

In some embodiments, the delivery monitor can turn the pump 115 off whena treatment session is completed. As one example, when the delivermonitor 136 determines that the pump has delivered the estimated dailycaloric intake requirement of the patient, the deliver monitor 136 canturn the pump off. As another example, when the delivery monitordetermines that the time period over which the enteral formula is to bedelivered has expired, the deliver monitor can turn the pump off. Thus,the pump 115 can be controlled by the controller via execution of thedelivery monitor, to stop enteral feeding based on one or moreparameters.

In some embodiments, the delivery monitor can be implemented to generateone or more alarms. The alarms can indicate improper administration,operation, configuring, and the like. The alarms can provide an audibleand/or visual indication to the user. For example, when the deliverymonitor 136 determines that the patient is not meeting the caloric goal,the deliver monitor 136 can generate an alarm, at which point the usermay choose to implement a compensatory bolus to compensate for thedetected calorie deficit. While generating an alarm in response to acalories deficit is provided as an exemplary alarm condition, thoseskilled in the art will recognize that other alarms can be generated.For example, the delivery monitor can generate an alarm upon detecting amalfunction of the pump, when the patient is being overfed, when thedelivery rate is too high or too low, and the like.

Using the compensation unit 138, the controller 150 can implement acompensatory bolus when it is determined that the estimated dailycaloric intake requirement of the patient is not being met based on acomparison of a quantity of calories delivered to the patient to theestimated caloric intake requirement. The compensation unit 138 canreceive a caloric deficit from the delivery monitor 136 and using thecompensation unit 138, the controller 150 can calculate an amount offormula to administer to compensate for the unmet caloric intake of thepatient. The compensation unit 138 can be used to provide an adjusteddelivery rate to the configuration unit 134, which can be used by thecontroller 150 to program the pump 115 to deliver the formula at theadjusted delivery rate for a specified period of time.

In some embodiments, the compensation unit 138 can be used to implementa stepped or graduated administration rate such that the adjusteddelivery rate increases and/or decrease over time. The compensatorybolus protocol can improve caloric intake for patients who are enterallyfed that have prolonged cessation of enteral feeding and/or who havefrequent feeding interruptions in the course of the day by compensatingcaloric deficits to achieve optimal daily caloric intake goal. Forexample, a period of time for which feeding must be stopped can bespecified prior to undergoing testing and/or surgical procedures.

The user interface unit 140 can be executed by the controller 150 toprovide a user interface on the display 105 to allow a user to interactwith the apparatus 100. The user interface 140 can be used to allow auser to retrieve and/or display patient information 122, treatmenthistories 124, formula information 126, and the like, and can allow theuser to enter information for use by the apparatus 100, such as patientinformation 122, formula information 126, and the like. For example, theuser can enter patient information 122 via the user interface that canbe stored and/or used when configuring the apparatus 100 and/ormonitoring usage of the apparatus 100. The user interface unit 140 canbe used to display usage parameters, such as a delivery rate at whichthe pump 150 is delivering feeding formula, a quantity of calories thathave delivered within a time period, an enteral formula selected fordelivery, and the like.

The communication port 145 can facilitate transmission and/or receipt ofinformation by the apparatus 100. For example, the apparatus 100 can becommunicative coupled to a communications network via the communicationsport 145 and the apparatus can communicate with the communicationsnetwork to transmit and/or receive information over the communicationsnetwork. The communication port 145 can be implemented using wiredand/or wireless interfaces. For example, the communication port 145 canbe configured to connect to an RJ45 cable to connect to the networkand/or with an IEEE 802.11 wireless interface. The controller 150 cancontrol the communication port 145 to transmit and/or receiveinformation, such as patient information, formula information,selections received via the user interface, a treatment history, and thelike.

FIG. 2 is a block diagram of an exemplary enteral feeding system 200(hereinafter “system 200”) that includes a computing device 210 and theenteral feeding pump 115. The computing device 210 can be a mainframe;personal computer (PC); laptop computer; workstation; handheld device,such as a PDA and/or smart phone; and the like, and can becommunicatively coupled to the pump 115. For example, the pump 115 canbe a peripheral device connected to the computing device 210. In theillustrated embodiment, the computing device 210 includes one or morecentral processing units (CPU) or controllers 212 (hereinafter“controllers 212”), and computer storage 214. The computing device 210can also include a display device 216. The display device 216 enablesthe computing device 200 to communicate with a user through a visualdisplay. The computing device 200 can further include data entrydevice(s) 218, such as a keyboard, touch screen, microphone, and/ormouse. The storage 214 can include computer readable mediumtechnologies, such as a floppy drive, hard drive, compact disc, tapedrive, Flash drive, optical drive, read only memory (ROM), random accessmemory (RAM), and the like. The storage 214 can include the patientinformation 122, treatment histories 124, and formula information 126,as well as applications 220 for operation the system 200.

The applications 220, such as an embodiment of the system 130 orcomponents thereof, can be resident in the storage 214. The storage 214can be local or remote to the computing device 210. The computing device210 includes network interface 222 for communicating with acommunications network. The controller 212 operates to run the system130 in storage 214 by executing instructions therein and storing dataresulting from the performed instructions, which may be output via adisplay 216 or by other mechanisms known to those skilled in the art.The computing device 210 can communicate with the pump 115 to configureand monitor the pump 115 using the system 130.

FIG. 3 depicts another exemplary enteral feeding system 300 (hereinafter“system 300”). The system 300 includes one or more servers 310 and 320communicatively coupled to one or more enteral feeding apparatuses 330and 340 via a communication network 250, which can be any network overwhich information can be transmitted between devices communicativelycoupled to the network. The apparatus 330 and 340 can include one ormore components of the apparatus 100 and/or the system 200. For example,in some embodiments, the apparatuses 330 and 340 can include the pump115 and controller 150 or 212. In some embodiments, the apparatuses 330and 340 can include the pump 115, controller 150 or 212, and the system130 or components thereof. The system 300 can also include one or moredatabase devices 360, which can be coupled to the servers 310/320 andapparatuses 330/340 via the communications network 350. The servers310/320 and database devices 360 can be implemented as computingdevices.

The servers 310/320, apparatuses 330/340, and/or databases 360 can storeinformation, such as formula information, patient information, treatmenthistories, and the like. In some embodiments, the system 130 can bedistributed among the servers 310/320, apparatuses 330/340, and/ordatabase devices 360 such that one or more components of the system 130and/or a portion of one or more components of the system 130 can beimplemented by a different device (e.g. servers, pumps, databases) inthe enteral feeding system 300. For example, the determination unit 132can be resident on the servers 310 and 320; the configuration unit 134,the delivery monitor 136, and compensation unit 138 can be resident onthe apparatuses 330 and 340; and the patient information 122 and formulainformation 126 can be stored in one or more of the database devices360.

FIG. 4 is an exemplary hospital environment 400 in which embodiments ofthe apparatus 100, system 200, and/or system 300 can be implemented. Thehospital environment 400 can include hospital treatment units 410 inwhich patients may require enteral feeding. Each of the units 410 caninclude embodiments of one or more of the apparatus 100, system 200, andor apparatus 330 (hereinafter collectively referred to as “feeding units420”). In some embodiments, the feeding units 420 can be connected to aserver 430, which can be in communication with a database device 440.Each feeding unit 420 can connect to the network via a RJ45 cable and/ora wireless interface. Information, such as formula information and/orpatient information input to the feeding units 420 by a user can betransferred to the sever 430, which can store the information in thedatabase device 440. The database 440 can be in communication with ahospital information system network 450 to facilitate access to thedatabase 440 by hospital departments 460. In this manner, information inthe database 440 can be distributed to the hospital departments 460,which can include a dietary and nutrition department, an administrationand reports department, a medical records and charting department, andthe like.

FIG. 5 is an exemplary illustration of an embodiment of a main viewscreen 500 of a user interface displayed by embodiments of the apparatus100, system 200, and system 300 (hereinafter collectively referred to as“feeding embodiments 502”). The view screen 500 can display informationincluding formula information, patient information, pump operationparameters, treatment history information, and the like. For example,the view screen 500 can display patient specific information to a userand can allow the user to input information by touching defined areas inthe screen, which can be used to interface with components of thefeeding embodiments 502 including, for example, the patient information122, the treatment histories 124, the formula information 126,components of the system 130, the pump 115, and the like.

The defined area 510 can be selected to display an enteral formula listusing the formula information 126. The list can include each individualenteral formula product name, nutrient value, calories, calories permilliliter, and the like. The user can select the defined area 510 tobrowse through the available formulas to be used when configuring thefeeding embodiments 502 for operation. When the user identifies anenteral formula to be used, the user can select the enteral formula fromthe list. In some embodiments, a data entry field can be displayed uponselecting the defined area 510 to permit searches for enteral formulasusing key words or terms. If the user is unable to find the formula inthe list, the user can enter formula information manually and theentered formula information can be stored.

The defined area 515 can be selected to access the deliver monitor 136and/or the compensation unit 138. Upon selection of the defined area515, the feeding embodiments 502 can display a compensatory bolusfeeding view to identify a calorie deficit for a patient based on theestimated daily caloric requirement of the patient and the quantity ofcalories delivered to the patient. The usage information stored bydelivery monitor 136 of the feeding embodiments 502 can provide acurrent nutritional status of the patient and facilitate compensation ofcaloric deficits using compensatory bolus feeding.

The defined area 520 can be selected to display patient informationinput by the user and/or retrieved from the patient information. Forexample, upon selection of the defined area 520, the user can input thepatient's height, weight, age, gender, and the like, into data entryfields and/or can retrieve patient information using a key word or termsearch. For example, selection of the defined area 520 can prompt theuser for a patient identifier number and can retrieve the patientinformation that corresponds to the patient identification numberentered by the user. Upon entry or selection of patient information, thefeeding embodiments 502 can use the patient information for controllingthe delivery of enteral formula. For example, once the patientinformation is identified, the determination unit can be used todetermine patient parameters including the BMI, BSA, and estimated dailycaloric intake requirement of the patient, which can be displayed indefined area 540.

The defined area 525 can display a delivery rate at which the pump ofthe feeding embodiments is programmed to deliver the enteral formula.The delivery rate can be determined by the feeding embodiments 502 whenthe enteral formula and patient information are identified. The definedarea 525 can also display the name of the enteral formula beingdelivered to the patient, with its caloric value, shown in the presentexample as calories per milliliter (cal/ml).

The defined area 530 can display a blinking LED light that can be viewedto ensure that the pump is functioning and administrating the enteralformula in accordance with the configuration of the feeding embodiments502. The defined area 530 can include an indicator to display the typeof administration of the enteral feeding being delivered, such as acontinuous, intermitted, bolus feeding, and the like.

The defined area 535 can be selected to change the operational state ofthe pump to a standby/hold state. The defined area 535 allows a user tostop the pump for procedures, intermittent disconnection from theenteral pump, and the like. When the user wishes to resume enteralfeeding, the user can select the defined area 535 and enteral feedingcan restart.

The defined area 545 can provide a real-time display of the date andtime. The feeding embodiments 502 can use the date and time to track andcontrol the actual time and day the administration of enteral formulawas delivered. The advantage of having a real-time clock gives the userthe ability to accurately monitor the actual caloric intake the patientreceives on a daily basis. This can facilitate accurate compensation ofenteral feeding when a caloric deficit is evident and visible in thefeeding embodiments 502.

The defined area 550 can be selected to display a history view screenthat stores patient specific treatment histories. The history viewscreen can be accessed to retrieve and/or view a daily caloric intakegoal, whether the caloric intake goal is being met, a caloric deficitbased on a comparison of calories delivered to the patient and thecalorie intake goal, and the like. The history view screen can provide aprecise and accurate nutritional status of the patient.

The defined area 560 can be used to control various parameters of thefeeding embodiments 502. For example, the defined area 560 can be usedto manually increase and/or decrease the delivery rate, which canprovide an override function to override the rate set by the feedingembodiments 502. In some embodiments, the user may require specialauthorization prior to overriding the delivery rate specified by thefeeding embodiments 502.

FIG. 6 is an exemplary screen 600 that can be displayed upon selectionof the defined area 520 (FIG. 5). The user can begin by entering patientinformation for a patient in data entry fields 610, such as patientgender, height, admission weight, the hospital unit department, and/orthe amount of kcal/kg to be used. In some embodiments, the data entryfields can be pre-populated in response to receiving a patientidentifier, such as the patient's name and/or patient identificationnumber. Once the patient information is entered and/or retrieved, thedetermination unit can calculate the BMI and BSA of the patient.

Upon selection of the calculate caloric intake requirement button 615,and the determination unit can determine the ideal body weight of thepatient, the adjusted body weight for the patient, and/or a weight usedfor the caloric intake requirement calculation, which can be theadmission weight, ideal body weight, or the adjusted body weight. Thedetermination unit can also calculate the estimated daily caloric intakerequirement for the patient. These patient parameters can be displayedin area 620. In some embodiments, the feeding embodiments can beprogrammed by particular units/departments in a hospital (for ex. aparticular unit may use an automatic set number of kcal/kg for thecommon patient in that specific unit) to have a default estimated dailycaloric intake requirement of 25-30 kcal/kg. In some embodiments, thedefault value can be modified by the user.

In some embodiment, the determination unit can be programmed to use theadjusted body weight when calculating the estimated daily caloricrequirement for patients with a BMI >30. In some embodiments, theadjusted body weight can be calculated using the Devine equation. Thedetermination unit can include different methods of calculating thedaily caloric intake requirements. In some embodiments, a selection of amethod of calculating the estimated daily caloric intake requirementscan be dependent on the user's preference, unit department, and/orhospital policy. Once the estimated daily caloric intake requirement iscalculated, a table 625 of the enteral formulas can be displayed. Thenames of the enteral formulas can listed in a column 630 along with thecalories per volume of the enteral formula. The column 632 can includeand estimated delivery rate at which the formula would be delivered toreach the estimated caloric intake requirement. The column 634 caninclude an estimated quantity of total calories to be delivered in a dayat the corresponding delivery rate. The column 636 can include aquantity of protein that would be delivered in the day for each enteralformula listed. Those skilled in the art will recognize that othernutritional values can be included in the table and monitored by thefeeding units.

FIG. 7 illustrates a process for entering information via the userinterface. A user can select whether this is a new patient (700). If thepatient is a new patient (702), a screen is displayed to the user inwhich the user inputs the patient information and prescribed enteralformula (704) and patient parameters are calculated and displayed (706).The patient parameters can include, for example, the estimated caloricrequirement, protein requirement, ideal and adjusted body weight,calculated weight, an enteral formula delivery rate for the patient, andthe like. In some embodiments, the feeding embodiments can set thedelivery rate based on, for example a time period of which the enteralformula is to be delivered and prompt the user to confirm (708). In someembodiments, the user is prompted to enter a desired delivery rate andcan confirm the delivery rate and the time period over which the formulato be delivered is determined by the determination unit (710). After thedelivery rate is specified, the user can start the pump and the userinterface returns to the main view screen (712).

If the patient is not a new patient (702), a review history screen menucan be displayed with patient information and formula informationcorresponding to the last patient to use the feeding embodiments (714).The user is prompted to review and verify the patient's information andconfirm that it is correct. If the information is not accurate, the userhas the option to change and modify the information (716). Once theappropriate information is established, the user can confirm therecalled delivery rate (718) and/or the user may also have the optionchange and modify the rate if needed (720). Once the appropriate rate isselected, the feeding embodiments have the capability to calculate theduration of time the pump was off, and therefore, the feedingembodiments can accurately calculate the caloric deficit of the patient.For example, the user then has the option to compensate and replace thecalories that the patient did not receive when the pump was turn off(722). If the user selects to compensate the patient's calories, theoption screen to compensate the patient's caloric deficit is displayed(724). Otherwise, the pump starts delivery enteral formula at theconfirmed delivery rate (726).

FIG. 8 illustrates programming a particular enteral feeding protocol fordelivery a compensatory bolus. The compensatory bolus feeding protocolis a feature that allows accurate calculation of the patient's totalcaloric deficit based on the time the enteral feeding was held,interrupted, and/or turned off. The compensatory bolus feature is notlimited to compensating caloric deficit and can compensate a patient ifthe user anticipates the patient's enteral feeding is to be interruptedin the future. Once the user proceeds to select the compensatory bolus(800), the feeding embodiments can determine the total caloric deficitof the patient (802). The user can be prompted to indicate whether thetotal caloric deficit is to be compensated (804).

If the total amount of caloric deficiency is desired to be compensated,the user can enter the residual volume of enteral formula remainingprior to administration of bolus feeding (806). If the user does notdesire to administer the total amount of caloric deficit, the user mayinput the desired volume and/or calories (808) followed by entering thepatient's residual volume (806). In some embodiments, the compensationunit of the feeding embodiments can include a safety feature that allowsthe user to assess the patient's tolerance of compensatory bolus feedingprior to administration. The patient's residual volume is input by theuser.

The safety parameters can be applied for the compensatory bolus protocolto limit the amount of residual volume prior to be administered using acompensatory bolus feed (810). For example, if the safety parameter isnot satisfied (e.g., if the residual volume is >250 ml), an alarm can begenerated indicating that the safety parameter is not satisfied (e.g.,the residual volume is too high) (812). In some embodiments, the safetylimit may be a hard limit that cannot be overridden, and therefore thebolus cannot be administered. In some embodiments, the safety limit canbe a soft limit that can be overridden and the user can override thealarm to facilitate delivery of the compensatory bolus (814). If theresidual volume is less than the safety limit parameter (810), the usercan administer the compensatory bolus and the length of time thecompensatory bolus will run to achieve total caloric compensation isdisplayed (816). The enteral feeding pump unit may be programmed todeliver the compensatory bolus feed by automatically increasing the rateover a period of time for example, increasing the target rate by 50%,over 6 hours. The rate increase parameter can be programmed by the userfor particular patients and/or location in the hospital.

FIG. 9 is an exemplary patient treatment history 900. The treatmenthistory can include a date and time entry 902, the enteral formulaadministered 904, the delivery rate 906 at which the enteral formula wasdelivered, a total enteral feeding volume administered in the last 24hours 908, and a total quantity of calories administered in the last 24hours 910 for each treatment session.

The history data can also include an estimated caloric intakerequirement for each session 912 and a 24 hours total caloric deficit ofthe patient 914 for each treatment session. The treatment history 900can also indicate a quantity of calories delivered to the patient via acompensatory bolus 916 for each session. The treatment history 900 caninterface with and/or be incorporated into the electronic medical recordof the patient, and can be included in an intake and output flowsheet aswell as a nutrition flowsheet. The treatment history 900 can be used tocalculate a cumulative amount of the patient's total caloric intake,and/or the percentage of the caloric goal met.

While exemplary embodiments have been described herein, it is expresslynoted that the present invention is not limited to these embodiments,but rather the intention is that additions and modifications to what isexpressly described herein also are included within the scope of theinvention. Moreover, it is to be understood that the features of thevarious embodiments described herein are not mutually exclusive and canexist in various combinations and permutations, even if suchcombinations or permutations are not made express herein, withoutdeparting from the spirit and scope of the invention.

1. An enteral feeding apparatus comprising: an enteral feeding pump todeliver enteral feeding formula to a patient; and a controllerconfigured to control delivery of the enteral feeding formula based on adelivery parameter determined using a relationship between a patientparameter associated with the patient and a caloric parameter associatedwith the enteral feeding formula; wherein the delivery parameter is adelivery rate of the enteral feeding formula; wherein the delivery rateis determined by generating a quotient of the estimated daily caloricintake requirement divided by the quantity of calories per specifiedvolume and dividing the quotient by a time period over which the enteralformula is to be delivered.
 2. The apparatus of claim 1, wherein thepatient parameter is an estimated daily caloric intake requirement forthe patient.
 3. The apparatus of claim 2, wherein the controllercalculates the daily estimated caloric intake requirement for thepatient based on patient information associated with the patient.
 4. Theapparatus of claim 3, wherein the estimated daily caloric intakerequirement is calculated using at least one of the Weir equation, theindirect calorimetry respiratory quotient formula, Harris Benedictequation, the ideal bodyweight equation, the Devine formula equation,and the adjusted body weight equation.
 5. The apparatus of claim 2,wherein the caloric parameter is a quantity of calories per a specifiedvolume of the enteral feeding formula.
 6. The apparatus of claim 2,wherein the controller monitors usage of the enteral feeding pump toidentify a quantity of calories administered to the patient.
 7. Theapparatus of claim 6, wherein the controller determines when theestimated daily caloric intake requirement is unmet based on acomparison of the quantity of calories administered to the patient andthe estimated daily caloric intake requirement.
 8. The apparatus ofclaim 6, wherein the controller generates a treatment history for thepatient that includes the quantity of calories delivery by the enteralfeeding pump.
 9. The apparatus of claim 8, further comprising: acommunication port to communicatively couple the apparatus to at leastone device, the controller controlling the communication port totransmit the treatment history to a medical records database toincorporate the treatment history into an electronic medical recordassociated with the patient.
 10. The apparatus of claim 2, wherein thecontroller identifies when the estimated daily caloric intakerequirement of the patient is unmet and determines a rate at which todeliver a compensatory bolus to compensate for the estimated dailycaloric intake requirement of the patient that is unmet.
 11. Theapparatus of claim 10, wherein the controller controls the enteralfeeding pump to deliver the enteral feeding formula at the rate.
 12. Theapparatus of claim 1, further comprising: storage to receive at leastone of the patient parameter and the caloric parameter, the controllerbeing configured to interface with the storage to retrieve the at leastone of the patient parameter and the caloric parameter.
 13. Theapparatus of claim 1, further comprising: a communication port tocommunicatively couple the apparatus to at least one device, thecontroller controlling the communication port to receive at least one ofthe patient parameter and the caloric parameter.
 14. The apparatus ofclaim 1, further comprising: an input device to receive a selection froma user of the enteral feeding formula and patient information, thepatient parameter and the caloric parameter being identified in responseto the selection.
 15. A enteral feeding system comprising: an enteralfeeding apparatus including a pump to deliver enteral feeding formula toa patient; a storage to store at least one of patient information andformula information; and a server in communication with the enteralfeeding pump and the storage, wherein at least one of the server and theenteral feeding apparatus configures the enteral feeding pump to deliverthe enteral feeding formula to satisfy the caloric intake requirement ofthe patient using a delivery parameter based on a relationship betweenthe estimated daily caloric intake requirement and a caloric parameterincluded in the enteral formula information; wherein the caloricparameter is a quantity of calories per a specified volume of theenteral feeding formula and the delivery parameter is a delivery rate ofthe enteral feeding formula; wherein at least one of the server and theenteral feeding apparatus determines the delivery rate by generating aquotient of the estimated daily caloric intake requirement divided bythe quantity of calories per a specified volume of feeding formula anddividing the quotient by a time period over which the enteral formula isto be delivered.
 16. The system of claim 15, wherein at least one of theserver and the enteral feeding apparatus determines the caloric intakerequirement of a patient based on patient information associated with apatient.
 17. The system of claim 15, wherein at least one of the serverand the enteral feeding apparatus identify enteral formula informationassociated with a enteral feeding formula selected to be administered tothe patient.
 18. The system of claim 15, wherein at least one of theserver and the enteral feeding apparatus monitors usage of the pump toidentify a quantity of calories administered to the patient.
 19. Thesystem of claim 18, wherein at least one of the server and the enteralfeeding apparatus determines when the estimated daily caloric intakerequirement is unmet based on a comparison of the quantity of caloriesadministered to the patient and the estimated daily caloric intakerequirement.
 20. The system of claim 18, wherein at least one of theserver and the enteral feeding apparatus generates an enteral feedingpump treatment history for the patient that includes the quantity ofcalories administered.
 21. The system of claim 15, wherein at least oneof the server and the enteral feeding apparatus identifies when acaloric intake requirement of the patient is unmet and determines a rateat which to deliver a compensatory bolus to compensate for the estimateddaily caloric intake requirement of the patient that is unmet.
 22. Thesystem of claim 15, wherein the enteral feeding apparatus includes aninput device to receive a selection from a user of the enteral feedingformula and patient information, the estimated daily caloric requirementand the caloric parameter being determined in response to the selection.23. An enteral feeding system comprising: a computing system includingat least one computing device, the computing system being configured to:determine a caloric intake requirement of a patient based on patientinformation associated with a patient; identify enteral formulainformation associated with a enteral feeding formula selected to beadministered to the patient; and configure an enteral feeding pump todeliver the enteral feeding formula using a delivery parameterdetermined based on a relationship between the estimated caloric intakerequirement and a caloric parameter included in the enteral formulainformation; wherein the caloric parameter is a quantity of calories pera specified volume of the enteral feeding formula and the deliveryparameter is a delivery rate determined by generating a quotient of theestimated daily caloric intake requirement divided by the quantity ofcalories per specified volume and dividing the quotient by a time periodover which the enteral formula is to be delivered.
 24. A method ofadministering enteral formula to a patient comprising: determining anestimated daily caloric intake requirement for a patient based onpatient information; configuring an enteral feeding pump to deliver theenteral feeding formula to satisfy the estimated daily caloric intakerequirement of the patient using a delivery parameter determined basedon a relationship between the estimated daily caloric intake requirementand a caloric parameter included in the enteral formula information;wherein the delivery parameter is a delivery rate of the enteral feedingformula; wherein the delivery rate is determined by generating aquotient of the estimated daily caloric intake requirement divided bythe quantity of calories per specified volume and dividing the quotientby a time period over which the enteral formula is to be delivered. 25.The method of claim 24, further comprising: administering the enteralfeeding formula in response to the configuring.
 26. The method of claim24, further comprising: monitoring a quantity of calories delivered bythe enteral feeding pump.
 27. The method of claim 24, furthercomprising: generating a treat history for the patient, the treatmenthistory including the quantity of calories.